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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS 14.0 ��-' � � <br />DESC <br />PARCEL TAX I.D.1t <br />cv��-� r , c�7A 9�"4 <br />LOT NO. BLOCK TRACT OR SUBOIVI�'ON M <br />�i'��- U���C� l..(-��-��lfj <br />TENANTNAME <br />CONTR. LICENSE M <br />USE OF BUILDING <br />WORK DESCRIPTION <br />C�IJ/le�r <br />�� �I�� St��l� <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Water healer <br />Sink (service/bar/mop/e�c.) <br />Backllow prevenler <br />Urinal <br />Drinking Foim�ain <br />Floor drain <br />Grease �rep <br />Rool drains <br />O�her __ _ <br />r-a�-i <br />;MIT p <br />�Q,y� 14� t� �( Su1 ��E'-�(�1f 4+1 � 4�S - 33U -�14-i <br />CONTACT FOR PERMIT PHONE <br />HEATSOURCE <br />[lectric _ Gas __ Other <br />CONTRACT PRIGt Vh wvRn <br />ov <br />3. azsv <br />NO. I TVPE OF FI%TURE OR ITEM <br />A/C - air handling unils <br />Forced air systems <br />Ges piping <br />Waler heater <br />Gas Grepiace <br />Gas range <br />Clolhes dryer <br />Rangehood <br />Exhaust tan <br />Heat pump <br />Unit heater <br />�oiler <br />Relrigeration <br />VJoodsrove <br />Other <br />CITY OF EVERETT LOCAL SALES TA% CODE IS �106 <br />I hereby certify Ihal I have read and examined this epplication and know iha same to be irue and r,orrec�. All provisions o( laws and <br />ordinances govemin,y Ihis Wpe of work will be complied wAh whelher specifed herein or nol The granting of a pennit does no� presume <br />to yive authorily lo violale or cancel the provision ol any other slate or Ivcal law regulaliny consiruclinn or Ihe pe�formence ol <br />conslruction. That I am authorized by the owner of this propedy to perbrm the work for which application is made and I comply with ihe <br />Ste�e Contractors Law 1�27 RCW and 290 200 WP.C. <br />, , -'' _. �-� _ Q,.a� -�c�(t� ( <br />Signat of wnedConiractor/Au�horized Agent De�e 1 2 <br />